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    Clinical Trial Results:
    A Randomized, Double-blind, Multicenter, Parallel-group, Placebo-controlled Study to Evaluate the Efficacy, Safety, and Tolerability of Aticaprant 10 mg as Adjunctive Therapy in Adult Participants with Major Depressive Disorder (MDD) with Moderate-to-severe Anhedonia and Inadequate Response to Current Antidepressant Therapy

    Summary
    EudraCT number
    2022-000461-41
    Trial protocol
    CZ   BG   FR   SK  
    Global end of trial date
    02 Apr 2025

    Results information
    Results version number
    v1(current)
    This version publication date
    27 Nov 2025
    First version publication date
    27 Nov 2025
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    67953964MDD3002
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT05550532
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Janssen-Cilag International N.V.
    Sponsor organisation address
    Turnhoutseweg 30, Beerse, Belgium, B-2340
    Public contact
    Clinical Registry Group, Janssen-Cilag International N.V., ClinicalTrialsEU@its.jnj.com
    Scientific contact
    Clinical Registry Group, Janssen-Cilag International N.V., ClinicalTrialsEU@its.jnj.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    12 Nov 2024
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    02 Apr 2025
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The main objective of the study was to evaluate the efficacy of aticaprant 10 mg compared with placebo as adjunctive therapy to an antidepressant in improving depressive symptoms in adult participants with major depressive disorder (MDD) with moderate-to-severe anhedonia (ANH+) who have had an inadequate response to current antidepressant therapy with an selective serotonin reuptake inhibitor (SSRI) or selective norepinephrine reuptake inhibitors (SNRI).
    Protection of trial subjects
    This study was conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki and that are consistent with Good Clinical Practices and applicable regulatory requirements.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    12 Jun 2022
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Argentina: 72
    Country: Number of subjects enrolled
    Bulgaria: 18
    Country: Number of subjects enrolled
    Brazil: 12
    Country: Number of subjects enrolled
    Czechia: 18
    Country: Number of subjects enrolled
    France: 20
    Country: Number of subjects enrolled
    United Kingdom: 9
    Country: Number of subjects enrolled
    Korea, Republic of: 19
    Country: Number of subjects enrolled
    Poland: 27
    Country: Number of subjects enrolled
    Slovakia: 36
    Country: Number of subjects enrolled
    Taiwan: 5
    Country: Number of subjects enrolled
    United States: 178
    Country: Number of subjects enrolled
    South Africa: 26
    Worldwide total number of subjects
    440
    EEA total number of subjects
    119
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    392
    From 65 to 84 years
    48
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    A total of 444 participants were enrolled in the study, of whom 440 received the treatment and were included in the analysis.

    Pre-assignment
    Screening details
    Adult participants aged 18 to 64 years who had major depressive disorder (MDD) with or without moderate-to-severe anhedonia (ANH+ or ANH-) and elderly participants aged 65 to 74 years with MDD (ANH+ and ANH-) who had an inadequate response to an ongoing antidepressant therapy were randomized in the study.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Placebo
    Arm description
    During double blind (DB) treatment phase, participants received placebo matching to aticaprant tablet orally once daily from Day 1 to Day 42 in addition to the ongoing antidepressant therapy (selective serotonin reuptake inhibitor/serotonin–norepinephrine reuptake inhibitor [SSRI/SNRI]). Participants were then followed up for safety up to 7 to 14 days after end of DB phase at Day 43 (up to Day 57). Participants who completed the DB phase (at Day 43) and were compliant to the study intervention were eligible to participate in a separate 52-week open-label long-term safety study 67953964MDD3003 (NCT05518149).
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Participants received placebo matching to aticaprant tablet orally once daily from Day 1 to Day 42.

    Arm title
    Aticaprant 10 mg
    Arm description
    During DB treatment phase, participants received aticaprant 10 milligram (mg) tablet orally once daily from Day 1 to Day 42 in addition to the ongoing antidepressant therapy (SSRI/SNRI). Participants were then followed up for safety up to 7 to 14 days after end of DB phase at Day 43 (up to Day 57). Participants who completed the DB phase (at Day 43) and were compliant to the study intervention were eligible to participate in a separate 52-week open-label long-term safety study 67953964MDD3003 (NCT05518149).
    Arm type
    Experimental

    Investigational medicinal product name
    Aticaprant 10 mg
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Participants received aticaprant 10 mg tablet orally once daily from Day 1 to Day 42.

    Number of subjects in period 1
    Placebo Aticaprant 10 mg
    Started
    223
    217
    Participants who entered follow-up phase
    21 [1]
    18 [2]
    Completed
    210
    207
    Not completed
    13
    10
         Consent withdrawn by subject
    7
    3
         Adverse event, non-fatal
    2
    3
         Unspecified
    -
    4
         Lost to follow-up
    4
    -
    Notes
    [1] - The number of subjects at this milestone seems inconsistent with the number of subjects in the arm. It is expected that the number of subjects will be greater than, or equal to the number that completed, minus those who left.
    Justification: Only reported subjects were planned to be included in this milestone.
    [2] - The number of subjects at this milestone seems inconsistent with the number of subjects in the arm. It is expected that the number of subjects will be greater than, or equal to the number that completed, minus those who left.
    Justification: Only reported subjects were planned to be included in this milestone.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Placebo
    Reporting group description
    During double blind (DB) treatment phase, participants received placebo matching to aticaprant tablet orally once daily from Day 1 to Day 42 in addition to the ongoing antidepressant therapy (selective serotonin reuptake inhibitor/serotonin–norepinephrine reuptake inhibitor [SSRI/SNRI]). Participants were then followed up for safety up to 7 to 14 days after end of DB phase at Day 43 (up to Day 57). Participants who completed the DB phase (at Day 43) and were compliant to the study intervention were eligible to participate in a separate 52-week open-label long-term safety study 67953964MDD3003 (NCT05518149).

    Reporting group title
    Aticaprant 10 mg
    Reporting group description
    During DB treatment phase, participants received aticaprant 10 milligram (mg) tablet orally once daily from Day 1 to Day 42 in addition to the ongoing antidepressant therapy (SSRI/SNRI). Participants were then followed up for safety up to 7 to 14 days after end of DB phase at Day 43 (up to Day 57). Participants who completed the DB phase (at Day 43) and were compliant to the study intervention were eligible to participate in a separate 52-week open-label long-term safety study 67953964MDD3003 (NCT05518149).

    Reporting group values
    Placebo Aticaprant 10 mg Total
    Number of subjects
    223 217 440
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    200 192 392
        From 65 to 74 years
    23 25 48
    Age continuous
    Units: Years
        arithmetic mean (standard deviation)
    49.3 ( 13.11 ) 49.1 ( 13.14 ) -
    Gender categorical
    Units: Subjects
        Female
    168 161 329
        Male
    55 56 111
    Race (NIH/OMB)
    Units: Subjects
        American Indian or Alaska Native
    0 1 1
        Asian
    15 16 31
        Native Hawaiian or Other Pacific Islander
    2 1 3
        Black or African American
    9 9 18
        White
    182 177 359
        More than one race
    2 2 4
        Unknown or Not Reported
    13 11 24
    Ethnicity (NIH/OMB)
    Units: Subjects
        Hispanic or Latino
    74 74 148
        Not Hispanic or Latino
    141 137 278
        Unknown or Not Reported
    8 6 14
    Region of enrollment
    Units: Subjects
        Argentina
    35 37 72
        Brazil
    8 4 12
        Bulgaria
    9 9 18
        Czech Republic
    11 7 18
        France
    10 10 20
        Poland
    13 14 27
        Slovakia
    19 17 36
        South Africa
    12 14 26
        Korea, Republic of
    9 10 19
        Taiwan
    3 2 5
        United Kingdom
    4 5 9
        United States
    90 88 178

    End points

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    End points reporting groups
    Reporting group title
    Placebo
    Reporting group description
    During double blind (DB) treatment phase, participants received placebo matching to aticaprant tablet orally once daily from Day 1 to Day 42 in addition to the ongoing antidepressant therapy (selective serotonin reuptake inhibitor/serotonin–norepinephrine reuptake inhibitor [SSRI/SNRI]). Participants were then followed up for safety up to 7 to 14 days after end of DB phase at Day 43 (up to Day 57). Participants who completed the DB phase (at Day 43) and were compliant to the study intervention were eligible to participate in a separate 52-week open-label long-term safety study 67953964MDD3003 (NCT05518149).

    Reporting group title
    Aticaprant 10 mg
    Reporting group description
    During DB treatment phase, participants received aticaprant 10 milligram (mg) tablet orally once daily from Day 1 to Day 42 in addition to the ongoing antidepressant therapy (SSRI/SNRI). Participants were then followed up for safety up to 7 to 14 days after end of DB phase at Day 43 (up to Day 57). Participants who completed the DB phase (at Day 43) and were compliant to the study intervention were eligible to participate in a separate 52-week open-label long-term safety study 67953964MDD3003 (NCT05518149).

    Subject analysis set title
    DB: Placebo
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    During DB treatment phase, participants received placebo matching to aticaprant tablet orally once daily from Day 1 to Day 42 in addition to the ongoing antidepressant therapy (SSRI/SNRI).

    Subject analysis set title
    DB: Aticaprant 10 mg
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    During the DB treatment phase, participants received aticaprant 10 mg tablet orally once daily from Day 1 to Day 42 in addition to the ongoing antidepressant therapy (SSRI/SNRI).

    Subject analysis set title
    FU: Placebo
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Participants who received placebo and completed DB phase entered the follow-up phase and were then followed up for safety up to 7 to 14 days after end of DB phase at Day 43 (up to Day 57).

    Subject analysis set title
    FU: Aticaprant 10 mg
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Participants who received aticaprant 10 mg and completed DB phase entered the follow-up phase and were then followed up for safety up to 7 to 14 days after end of DB phase at Day 43 (up to Day 57).

    Primary: Change from Baseline to Day 43 in the Montgomery-Asberg Depression Rating Scale (MADRS) Total Score

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    End point title
    Change from Baseline to Day 43 in the Montgomery-Asberg Depression Rating Scale (MADRS) Total Score
    End point description
    The MADRS is a clinician-rated scale designed to measure depression severity and detect changes due to antidepressant treatment. The scale consists of 10 items (apparent sadness, reported sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, lassitude, inability to feel, pessimistic thoughts, and suicidal thoughts), each of which is scored from 0 (item not present or normal) to 6 (severe or continuous presence of symptoms). MADRS total score is the sum of scores from individual question items, which ranges from 0 to 60; higher scores represent a more severe condition. Negative change in MADRS total score indicates improvement. Full analysis set (ANH+) included all adult randomized participants in rest of the world (ROW; countries/territories other than China) with MDD ANH+ who received at least 1 dose of study intervention. Here, 'N' (overall number of participants analyzed) signifies number of participants evaluable for this outcome measure.
    End point type
    Primary
    End point timeframe
    Baseline (Day 1) to Day 43
    End point values
    Placebo Aticaprant 10 mg
    Number of subjects analysed
    159
    154
    Units: Units on a scale
        least squares mean (standard error)
    -9.4 ( 0.96 )
    -10.0 ( 0.96 )
    Statistical analysis title
    Statistical Analysis 1
    Comparison groups
    Placebo v Aticaprant 10 mg
    Number of subjects included in analysis
    313
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.67
    Method
    Mixed Model for Repeated Measures Model
    Parameter type
    Least Square Mean Difference
    Point estimate
    -0.5
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -2.95
         upper limit
    1.9
    Variability estimate
    Standard error of the mean
    Dispersion value
    1.23

    Secondary: Change from Baseline to Day 43 in Dimensional Anhedonia Rating Scale (DARS) Total Score

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    End point title
    Change from Baseline to Day 43 in Dimensional Anhedonia Rating Scale (DARS) Total Score
    End point description
    The DARS is a 17-item self-report questionnaire that is designed to assess anhedonia in MDD across the 4 domains: hobbies, social activities, food/drink, and sensory experience. The DARS scale measures desire, motivation, effort, and consummatory pleasure. The DARS is rated on a 5-point Likert scale (0=not at all, 1=slightly, 2=moderately, 3=mostly, 4=very much) and responses are summed to generate the total score (range of 0 to 68). A lower total score is indicative of greater anhedonia. Positive changes in DARS total score indicate improvement. Full analysis set (ANH+) included all adult randomized participants in ROW (countries/territories other than China) with MDD ANH+ who received at least 1 dose of study intervention. Here, 'N' (overall number of participants analyzed) signifies number of participants evaluable for this outcome measure.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 1) to Day 43
    End point values
    Placebo Aticaprant 10 mg
    Number of subjects analysed
    150
    147
    Units: Units on a scale
        least squares mean (standard error)
    8.2 ( 1.39 )
    8.8 ( 1.39 )
    No statistical analyses for this end point

    Secondary: Change from Baseline Over Time in MADRS Total Score

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    End point title
    Change from Baseline Over Time in MADRS Total Score
    End point description
    The MADRS is a clinician-rated scale designed to measure depression severity and detect changes due to antidepressant treatment. The scale consists of 10 items (apparent sadness, reported sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, lassitude, inability to feel, pessimistic thoughts, and suicidal thoughts), each of which is scored from 0 (item not present or normal) to 6 (severe or continuous presence of symptoms). MADRS total score is the sum of scores from individual question items, which ranges from 0 to 60; higher scores represent a more severe condition. Negative change indicates improvement. Full analysis set (ANH+) included all adult randomized participants in ROW with MDD ANH+ who received at least 1 dose of study intervention. Here, 'N' (overall number of participants analyzed) signifies participants evaluable for this outcome measure and 'n' (number analyzed) signifies number of participants analyzed at specified timepoints.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 1), Day 15, Day 29, and Day 43
    End point values
    Placebo Aticaprant 10 mg
    Number of subjects analysed
    161
    160
    Units: Units on a scale
    least squares mean (standard error)
        Day 15 (n= 161, 160)
    -4.4 ( 0.75 )
    -5.4 ( 0.74 )
        Day 29 (n=159, 157)
    -7.5 ( 0.89 )
    -8.0 ( 0.89 )
        Day 43 (n=159, 154)
    -9.4 ( 0.96 )
    -10.0 ( 0.96 )
    No statistical analyses for this end point

    Secondary: Percentage of Participants who Achieved Response on Depressive Symptoms Scale Based on MADRS Total Score at Day 43

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    End point title
    Percentage of Participants who Achieved Response on Depressive Symptoms Scale Based on MADRS Total Score at Day 43
    End point description
    Responders are defined as participants with a >=50 percent (%) improvement in the MADRS total score from baseline to a given timepoint. The MADRS is a clinician-rated scale designed to measure depression severity and detect changes due to antidepressant treatment. The scale consists of 10 items (apparent sadness, reported sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, lassitude, inability to feel, pessimistic thoughts, and suicidal thoughts), each of which is scored from 0 (item not present or normal) to 6 (severe or continuous presence of symptoms). MADRS total score is the sum of scores from individual question items, which ranges from 0 to 60; higher scores represent a more severe condition. Negative change in MADRS total score indicates improvement. Full analysis set (ANH+) included all adult randomized participants in ROW (countries/territories other than China) with MDD ANH+ who received at least 1 dose of study intervention.
    End point type
    Secondary
    End point timeframe
    At Day 43
    End point values
    Placebo Aticaprant 10 mg
    Number of subjects analysed
    166
    165
    Units: Percentage of participants
        number (not applicable)
    28.3
    27.9
    No statistical analyses for this end point

    Secondary: Percentage of Participants With Remission of Depressive Symptoms Based on MADRS Total Score at Day 43

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    End point title
    Percentage of Participants With Remission of Depressive Symptoms Based on MADRS Total Score at Day 43
    End point description
    Participant is defined as a remitter at a given time point if the MADRS total score is less than or equal to (<=)10 at that time point. The MADRS is a clinician-rated scale designed to measure depression severity and detect changes due to antidepressant treatment. The scale consists of 10 items (apparent sadness, reported sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, lassitude, inability to feel, pessimistic thoughts, and suicidal thoughts), each of which is scored from 0 (item not present or normal) to 6 (severe or continuous presence of symptoms). MADRS total score is the sum of scores from individual question items, which ranges from 0 to 60; higher scores represent a more severe condition. Negative change in MADRS total score indicates improvement. Full analysis set (ANH+) included all adult randomized participants in ROW (countries/territories other than China) with MDD ANH+ who received at least 1 dose of study intervention.
    End point type
    Secondary
    End point timeframe
    At Day 43
    End point values
    Placebo Aticaprant 10 mg
    Number of subjects analysed
    166
    165
    Units: Percentage of participants
        number (not applicable)
    16.3
    15.8
    No statistical analyses for this end point

    Secondary: Change from Baseline to Day 43 in Patient Health Questionnaire, 9-Item (PHQ-9) Total Score

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    End point title
    Change from Baseline to Day 43 in Patient Health Questionnaire, 9-Item (PHQ-9) Total Score
    End point description
    The PHQ-9 is a 9-item, participant reported outcome measure to assess depressive symptoms. The scale scores each of the 9 symptom domains of the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5) MDD criteria. Each item is rated on a 4 point scale (0=not at all, 1=several days, 2=more than half the days, and 3=nearly every day). The participant's item responses are summed to provide a total score (range of 0 to 27), with higher scores indicating greater severity of depressive symptoms. The severity of the PHQ-9 is categorized as follows: none-minimal (0-4), mild (5-9), moderate (10-14), moderately severe (15-19) and severe (20-27). Negative changes in PHQ-9 total score indicate improvement. Full analysis set (ANH+) included all adult randomized participants in ROW with MDD ANH+ who received at least 1 dose of study intervention. Here, 'N' (overall number of participants analyzed) signifies number of participants evaluable for this outcome measure.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 1) to Day 43
    End point values
    Placebo Aticaprant 10 mg
    Number of subjects analysed
    150
    150
    Units: Units on a scale
        least squares mean (standard error)
    -5.5 ( 0.58 )
    -5.2 ( 0.58 )
    Statistical analysis title
    Statistical Analysis 2
    Comparison groups
    Placebo v Aticaprant 10 mg
    Number of subjects included in analysis
    300
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Least Square Mean Difference
    Point estimate
    0.3
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.13
         upper limit
    1.71
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.72

    Secondary: Change from Baseline Over Time in DARS Total Score

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    End point title
    Change from Baseline Over Time in DARS Total Score
    End point description
    The DARS is a 17-item self-report questionnaire that is designed to assess anhedonia in MDD across the 4 domains: hobbies, social activities, food/drink, and sensory experience. The DARS scale measures desire, motivation, effort, and consummatory pleasure. The DARS is rated on a 5-point Likert scale (0=not at all, 1=slightly, 2=moderately, 3=mostly, 4=very much) and responses are summed to generate the total score (range of 0 to 68). A lower total score is indicative of greater anhedonia. Positive changes in DARS total score indicate improvement. Full analysis set (ANH+) included all adult randomized participants in ROW (countries/territories other than China) with MDD ANH+ who received at least 1 dose of study intervention. Here, 'N' (overall number of participants analyzed) signifies participants evaluable for this outcome measure and 'n' (number analyzed) signifies number of participants who were analyzed at specified timepoints.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 1), Day 15, Day 29, and Day 43
    End point values
    Placebo Aticaprant 10 mg
    Number of subjects analysed
    152
    149
    Units: Units on a scale
    least squares mean (standard error)
        Day 15 (n=152, 149)
    3.5 ( 1.17 )
    4.2 ( 1.17 )
        Day 29 (n=148, 146)
    6.9 ( 1.27 )
    7.1 ( 1.27 )
        Day 43 (n=150, 147)
    8.2 ( 1.39 )
    8.8 ( 1.39 )
    No statistical analyses for this end point

    Secondary: Change from Baseline Over Time in the PHQ-9 Anhedonia-specific Item (PHQ-9, item 1)

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    End point title
    Change from Baseline Over Time in the PHQ-9 Anhedonia-specific Item (PHQ-9, item 1)
    End point description
    The PHQ-9 is a 9-item, participant reported outcome measure to assess depressive symptoms. The scale scores each of the 9 symptom domains of the DSM-5 MDD criteria. Each item is rated on a 4 point scale (0=not at all, 1=several days, 2=more than half the days, and 3=nearly every day). The participant's item responses are summed to provide a total score (range of 0 to 27), with higher scores indicating greater severity of depressive symptoms. The severity of the PHQ-9 is categorized as follows: none-minimal (0-4), mild (5-9), moderate (10-14), moderately severe (15-19) and severe (20-27). Negative changes in PHQ-9 total score indicate improvement. Full analysis set (ANH+) included all adult randomized participants in ROW who received at least 1 dose of study intervention. Here, 'N' (overall number of participants analyzed) signifies participants evaluable for this outcome measure and 'n' (number analyzed) signifies number of participants who were analyzed at specified timepoints.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 1), Day 15, Day 29, and Day 43
    End point values
    Placebo Aticaprant 10 mg
    Number of subjects analysed
    157
    152
    Units: Units on a scale
    arithmetic mean (standard deviation)
        Day 15 (n=157, 152)
    -0.4 ( 0.93 )
    -0.6 ( 1.08 )
        Day 29 (n=149, 149)
    -0.7 ( 1.00 )
    -0.8 ( 1.05 )
        Day 43 (n=150, 150)
    -0.9 ( 1.12 )
    -0.9 ( 1.08 )
    No statistical analyses for this end point

    Secondary: Percentage of Participants With a Score Less Than (<) 2 in the PHQ-9 Anhedonia-specific Item (PHQ-9, item 1) at Day 43

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    End point title
    Percentage of Participants With a Score Less Than (<) 2 in the PHQ-9 Anhedonia-specific Item (PHQ-9, item 1) at Day 43
    End point description
    The PHQ-9 is a 9-item, participant reported outcome measure to assess depressive symptoms. The scale scores each of the 9 symptom domains of the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5) MDD criteria. Each item is rated on a 4 point scale (0=not at all, 1=several days, 2=more than half the days, and 3=nearly every day). The participant's item responses are summed to provide a total score (range of 0 to 27), with higher scores indicating greater severity of depressive symptoms. The severity of the PHQ-9 is categorized as follows: none-minimal (0-4), mild (5-9), moderate (10-14), moderately severe (15-19) and severe (20-27). Full analysis set (ANH+) included all adult randomized participants in ROW (countries/territories other than China) with MDD ANH+ who received at least 1 dose of study intervention. Here, 'N' (overall number of participants analyzed) signifies number of participants evaluable for this outcome measure.
    End point type
    Secondary
    End point timeframe
    At Day 43
    End point values
    Placebo Aticaprant 10 mg
    Number of subjects analysed
    132
    136
    Units: Percentage of participants
        number (not applicable)
    50.8
    46.3
    No statistical analyses for this end point

    Secondary: Change from Baseline Over Time in Patient Reported Outcomes Measurement Information System Short Form - Ability to Participate in Social Roles and Activities - 8a (PROMIS-APS 8a)

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    End point title
    Change from Baseline Over Time in Patient Reported Outcomes Measurement Information System Short Form - Ability to Participate in Social Roles and Activities - 8a (PROMIS-APS 8a)
    End point description
    This 8-item measure assesses participants' ability to participate in social roles and activities with degree of involvement in social roles, activities, and responsibilities, including work, family, friends, and leisure. Each item is rated on a 5-point ordinal scale (1=always, 2=usually, 3=sometimes, 4=rarely, 5=never), with higher scores indicating better social functioning. The total scores of PROMIS-APS 8a are scaled on a T-score metric with a mean of 50 and a standard deviation of 10. The total score ranges from 8 to 40 and T-score ranges from 25.9 to 65.4, a higher score indicates better social functioning. Positive change in score indicates improvement. Full analysis set (ANH+) included all adult randomized participants in ROW who received at least 1 dose of study intervention. Here, 'N' (overall number of participants analyzed) is participants evaluable for this outcome measure and 'n' (number analyzed) is number of participants analyzed at specified timepoints.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 1), Day 15, Day 29, and Day 43
    End point values
    Placebo Aticaprant 10 mg
    Number of subjects analysed
    142
    134
    Units: T-score
    least squares mean (standard error)
        Day 15 (n=141, 132)
    1.4 ( 0.54 )
    1.5 ( 0.55 )
        Day 29 (n=139, 130)
    3.2 ( 0.57 )
    3.1 ( 0.59 )
        Day 43 (n=142, 134)
    3.9 ( 0.63 )
    4.3 ( 0.64 )
    No statistical analyses for this end point

    Secondary: DB Treatment Phase: Percentage of Participants With Treatment Emergent Adverse Events (TEAEs)

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    End point title
    DB Treatment Phase: Percentage of Participants With Treatment Emergent Adverse Events (TEAEs)
    End point description
    Percentage of participants with TEAEs during DB treatment phase are reported. An AE is any untoward medical occurrence in a clinical study participant administered a medicinal (investigational or non-investigational) product. An AE does not necessarily have a causal relationship with the intervention. TEAE is defined as any AE occurring at or after the initial administration of study intervention through the end of DB phase. Safety analysis set included all randomized participants (adults and elderly) in ROW (countries/territories other than China) who received at least 1 dose of study intervention.
    End point type
    Secondary
    End point timeframe
    From start of treatment (Day 1) up to Day 43
    End point values
    DB: Placebo DB: Aticaprant 10 mg
    Number of subjects analysed
    223
    217
    Units: Percentage of participants
        number (not applicable)
    38.1
    44.2
    No statistical analyses for this end point

    Secondary: Follow-up (FU) Phase: Percentage of Participants With AEs

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    End point title
    Follow-up (FU) Phase: Percentage of Participants With AEs
    End point description
    Percentage of participants with AEs during FU phase are reported. An AE is any untoward medical occurrence in a clinical study participant administered a medicinal (investigational or non-investigational) product. An AE does not necessarily have a causal relationship with the intervention. Follow-up analysis set included all randomized participants in ROW (countries/territories other than China) who entered the follow-up phase after the doubleblind treatment phase.
    End point type
    Secondary
    End point timeframe
    From Day 44 up to Day 57
    End point values
    FU: Placebo FU: Aticaprant 10 mg
    Number of subjects analysed
    21
    18
    Units: Percentage of participants
        number (not applicable)
    0
    5.6
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    DB Treatment Phase: From Day 1 (start of treatment) up to Day 43; Follow-up Phase: From Day 44 up to Day 57
    Adverse event reporting additional description
    DB phase: Safety analysis set: all randomized participants (adults and elderly) in ROW (countries/territories other than China) who received at least 1 dose of study treatment. FU phase population: all randomized participants in ROW (countries/territories other than China) who entered the FU phase after the DB treatment phase.
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    27.1
    Reporting groups
    Reporting group title
    DB: Placebo
    Reporting group description
    During DB treatment phase, participants received placebo matching to aticaprant tablet orally once daily from Day 1 to Day 42 in addition to the ongoing antidepressant therapy (SSRI/SNRI).

    Reporting group title
    DB: Aticaprant 10 mg
    Reporting group description
    During the DB treatment phase, participants received aticaprant 10 mg tablet orally once daily from Day 1 to Day 42 in addition to the ongoing antidepressant therapy (SSRI/SNRI).

    Reporting group title
    FU: Placebo
    Reporting group description
    Participants who received placebo and completed DB phase entered follow-up phase and were then followed up for safety up to 7 to 14 days after end of DB phase at Day 43 (up to Day 57).

    Reporting group title
    FU: Aticaprant 10 mg
    Reporting group description
    Participants who received aticaprant 10 mg and completed DB phase entered follow-up phase and were then followed up for safety up to 7 to 14 days after end of DB phase at Day 43 (up to Day 57).

    Serious adverse events
    DB: Placebo DB: Aticaprant 10 mg FU: Placebo FU: Aticaprant 10 mg
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 223 (0.45%)
    0 / 217 (0.00%)
    0 / 21 (0.00%)
    0 / 18 (0.00%)
         number of deaths (all causes)
    0
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    0
    Psychiatric disorders
    Anxiety
         subjects affected / exposed
    1 / 223 (0.45%)
    0 / 217 (0.00%)
    0 / 21 (0.00%)
    0 / 18 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    DB: Placebo DB: Aticaprant 10 mg FU: Placebo FU: Aticaprant 10 mg
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    18 / 223 (8.07%)
    39 / 217 (17.97%)
    0 / 21 (0.00%)
    1 / 18 (5.56%)
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    9 / 223 (4.04%)
    17 / 217 (7.83%)
    0 / 21 (0.00%)
    0 / 18 (0.00%)
         occurrences all number
    9
    19
    0
    0
    Skin and subcutaneous tissue disorders
    Pruritus
         subjects affected / exposed
    9 / 223 (4.04%)
    25 / 217 (11.52%)
    0 / 21 (0.00%)
    0 / 18 (0.00%)
         occurrences all number
    9
    32
    0
    0
    Psychiatric disorders
    Suicidal Ideation
         subjects affected / exposed
    1 / 223 (0.45%)
    1 / 217 (0.46%)
    0 / 21 (0.00%)
    1 / 18 (5.56%)
         occurrences all number
    1
    1
    0
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    22 Feb 2023
    The overall rationale for the amendment was to made updates based on feedback received from interactions with health authorities, to ensure alignment across the program and to improve participant selection.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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